Provider Demographics
NPI:1487412532
Name:WILLOW CREEK REAL ESTATES PROPERTIES
Entity type:Organization
Organization Name:WILLOW CREEK REAL ESTATES PROPERTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CRYSHENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-319-5805
Mailing Address - Street 1:404 N HOUSTON LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31028-1120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2738 WALDEN RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31216-7524
Practice Address - Country:US
Practice Address - Phone:478-788-2118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility